Caudal anaesthesia (or caudal anesthesia), is a form of neuraxial

regional anaesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...

conducted by accessing the epidural space via the sacral hiatus. It is typically used in paediatrics to provide peri- and post-operative analgesia for surgeries below the umbilicus. In adults it is used for chronic low back pain management. It can be used as an alternative to general anaesthesia or as adjunct to it.

Indications

Caudal anaesthesia is a relatively low-risk technique commonly used, either on its own or in combination with sedation or general anaesthesia. Caudal anesthesia may be favored for sub-umbilical region surgeries in the pediatric population, such as inguinal hernia repair, circumcision, hypospadias repair, anal atresia, or to immobilise newborns with hip dysplasia. Success rate is limited when used for mid-abdominal interventions such as umbilical hernia repair. This is due to the unpredictable cephalad spread of the local anesthetics. It may also be used in patients with lumbar spinal stenosis, lumbar spinal radiculopathy, postlaminectomy pain, or nonspecific chronic low back pain that fail conservative treatment. List of indications: * Obstetrics and general surgery below the umbilicus * Acute and chronic pain refractory to conservative management * Patients with previous lumbar spine surgery * Patients who are “anticoagulated” or have coagulopathy

Contraindications

Contraindications to caudal anesthesia include patient or guardian refusal, localized infection over the sacral area, severe coagulopathy and elevated

intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury ( mmHg) and at rest, is normally 7–15 mmHg for a supine adult ...

. It should also be avoided in case of allergies to local anesthetics to be used for the procedure.

Risks and complications

Serious complications are infrequent. When they occur, they are similar those encountered with lumbar epidural block Some of the risks associated with caudal anesthesia include: * Needle misplacement leading to subdural, intravascular, intraosseous or antesacral injection with rectum perforation * Infection, such as epidural abscess, meningitis or sacral osteomyelitis *

Low blood pressure Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the di ...

* Injury to the nerve roots * Epidural hematoma *

Local anesthetic toxicity A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general an ...

, more frequently following caudal anesthesia than it does following lumbar or thoracic blocks. The most common complications of the anatomic technique for caudal block include: needle misplacement, subarachnoid puncture, and

intrathecal Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, or into the subarachnoid space so that it reaches the cerebrospinal fluid (CSF) and is useful in spinal anesthesia, chemotherapy, or pain ma ...

intravascular The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away f ...

injections.

Technique

A caudal block may be performed by using anatomic landmarks to guide needle insertion. However, greatest accuracy is obtained by performing caudal blocks using imaging guidance, such as ultrasound or fluoroscopy. Common local anesthetic drugs for caudal blockade are bupivacaine and ropivacaine. Opioids, ketamine or opioids are common drug added as they prolong the postoperative analgesia while minimizing the motor block.

History

Caudal anesthesia was first described independently in 1901 by Fernand Cathelin and Jean-Athanase Sicard. It predates the lumbar epidural approach which was described by Fidel Pagés Miravé in 1921. However, the high failure rate found in caudal anesthesia (5 to 10%) limited its popularity until the 1940s when it resurfaced in obstetrics anaesthesia. The first publication to describe caudal anaesthesia in children was published by Meredith Campbell in 1933.

References